Provider Demographics
NPI:1942546387
Name:CORSETTO, ANGELA S (LMP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:S
Last Name:CORSETTO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7054 123RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1215
Mailing Address - Country:US
Mailing Address - Phone:425-829-0552
Mailing Address - Fax:
Practice Address - Street 1:9716 NE JUANITA DR
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4202
Practice Address - Country:US
Practice Address - Phone:425-823-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA172M00000XOtherCHIROPRACTOR